title: Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients.
abstract: There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.
authors.affiliation: a Centre for Health Research, University of Western Sydney , Sydney , Australia .
authors.forename: Jane M
authors.initials: JM
authors.lastname: Ussher
authors.forename: Janette
authors.initials: J
authors.lastname: Perz
authors.forename: Emilee
authors.initials: E
authors.lastname: Gilbert
authors.forename: W K Tim
authors.initials: WK
authors.lastname: Wong
authors.forename: Catherine
authors.initials: C
authors.lastname: Mason
authors.forename: Kim
authors.initials: K
authors.lastname: Hobbs
authors.forename: Laura
authors.initials: L
authors.lastname: Kirsten
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020377:Self Efficacy; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology; D012747:Sexual Partners / Q000523:psychology; D019529:Sexuality; D012944:Social Support